Management of Acute Type A Aortic Dissection after Thrombolytic Therapy for Cerebral Infarction

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  • Saitoh Masato
    Department of Cardiovascular Surgery, Ayase Heart Hospital, Nurse Practitioner
  • Yamasaki Takuma
    Department of Cardiovascular Surgery, Ayase Heart Hospital
  • Tanabe Tomoaki
    Department of Cardiovascular Surgery, Ayase Heart Hospital
  • Tochigi Shuichi
    Department of Cardiovascular Surgery, Ayase Heart Hospital
  • Tatebe Shoh
    Department of Cardiovascular Surgery, Ayase Heart Hospital
  • Tei Imun
    Department of Cardiovascular Surgery, Ayase Heart Hospital

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  • 脳梗塞に対して血栓溶解療法を施行後に急性A型大動脈解離が判明し緊急手術により救命した1例

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<p>A 57-year-old man with cerebral infarction who was treated at another hospital with 24 million IU of recombinant tissue Plasminogen Activator was referred to our hospital after he was found to have acute type A aortic dissection. His primary complaint at presentation was partial paralysis of the left upper limb. Contrast-enhanced computed tomography scan revealed dissection of the three branches of the neck, a narrowed true lumen in the right common carotid artery, and an opening in the aortic root. Echocardiography revealed severe aortic regurgitation. We urgently performed total arch aortic replacement with the frozen elephant trunk technique and aortic valvuloplasty. We administered high doses of tranexamic acid in the perioperative period and applied intraoperative maneuvers. The patient was discharged without complications. Our results suggest that perioperative preventive measures against hemorrhage, such as reconstruction of the dissected neck branch as early as possible and resumption of blood flow even when recombinant tissue Plasminogen Activator has been administered, can lead to neurological improvement and ultimately save the patient’s life.</p>

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